ANGIOGRAPHY VS DOPPLER SONOGRAPHY TO PREVENT VARICEAL HEMORRHAGE

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. An attempt to determine if angiography (X-ray study of vessels) alone, or ultrasound and endoscopy-dictated angiography is more effective in patients who hemorrhage after a shunt has been placed into the hepatic veins to bring blood to the liver. Cirrhosis of the liver can cause the retention of fluids in over 60% of its patients. This fluid retention which does not respond to treatment can be associated with discomfort, difficulty breathing, malnutrition, liver and kidney failure, and death and increased risk of death following liver transplant. A relatively new procedure called transjugular intrahepatic portasystemic shunt (TIPS) creates a channel between veins which brings blood into the veins and out of the liver. The channel has been kept open by putting a metal tube-like structure into it. This changes the path of blood flow from the veins that are bleeding. The TIPS channel may close down due to the ingrowth of tissue into it from the surrounding liver. The chances of this occurring range from 50-60% by six months to 75-80% by one year. If this occurs, there is the risk of internal bleeding from varicose veins in the stomach and esophagus as well as a reaccumulation of fluid in the abdomen. A way to check the shunt and to repair it is very necessary. 60 patients will be admitted to the General Clinical Research Center. They will have had the TIPS procedure and lab tests will be done during the initial assessment. Patients will be randomized into two groups. TIPS must be functioning well for 7-10 days after placement. One group will have repeated angiography (x-ray of vessels after a dye has been injected into them) at six month intervals for two years during which a needle will be inserted into a neck vein and a fine tube will be threaded into the liver to measure pressure in the veins bringing blood into the liver and to check for narrowing of the shunt. The narrowing can be corrected by stretching the TIPS with a balloon and a new stent placement. Angiography will also be performed if there are clinical signs of bleeding. The second group will have repeated ultrasounds and endoscopy (an instrument insertion into a hollow organ for viewing) to view the esophagus, stomach, and upper small intestine. If problems are indicated, angiography will be performed to confirm the findings.